Page 23 - Delaware Medical Journal - February 2018

CASE REPORT
FIGURE 2
Nivolumab binds the PD-1 receptors on T cells and prevents suppression of immune reaction against abnormal tumor cells.
CONCLUSION
This presentation initially appeared
to be a straight forward case of sepsis and diabetic ketoacidosis causing a
toxic metabolic encephalopathy. But it rapidly proved to be a rare and dangerous medical emergency requiring prompt treatment. In this patient, with no history of thyroid dysfunction, the likely cause was autoimmune thyroiditis caused by therapy with iplimumab and nivolumab. This very rare but serious side effect is more likely to occur when iplimumab and nivolumab are used in combination than when used individually. It cardiac function, changes in mentation with hallucinations and agitation, respiratory compromise, and diabetic ketoacidosis. This case highlights and summarizes the clinical approach for the diagnosis, treatment, and stabilization of an acutely ill and decompensating patient presenting with a raging thyroid storm.
CONTRIBUTING AUTHORS
■ FAZAL ALI, DO is an Internal Medicine Resident at Christiana Care Health System in Newark, Del.
■ GREGORY MASTERS, MD is an Internal Medicine Specialist and Medical Oncologist at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System in Newark, Del. and an associate professor at Thomas Jefferson University Medical School in Philadelphia.
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